“My sons and daughters had a meeting without me and decided they wanted me to stop driving, but they’re making a big deal out of nothing. I’m very comfortable on the road. I’ve driven longer than they’ve been alive.”
This quotation from a person recently diagnosed with dementia appears in “At the Crossroads,” an excellent guide developed by The Hartford Financial Services Group, the MIT Age Lab, and Connecticut Community Care. Already, 150,000 copies have been distributed free of charge; I recommend it to elders and their families who may face difficult decisions about driving.
At a daylong conference last week hosted by MIT, researchers reported their findings on the complicated and often agonizing driving decisions confronting older Americans and their families.
Joseph Coughlin, director of the Age Lab, summarized some of what has been discovered thus far about the habits of drivers over age 50. In his words, “the data sheds new light on how older people define the driving decision; choose to self-regulate their driving behavior; weigh personal risk and safety as a function of health and age; and, what role families, physicians and other unwilling participants have on the driving decision.”
The quotation at the top of this column shows there are wrong ways of dealing with the situation. For the adult children of the gentleman in question to have made a unilateral decision to stop him from driving was clearly wrongheaded and a surefire method for getting their father’s back up.
No self-respecting parent could be expected to accept a prefabricated plan like that one without feeling threatened and even outraged. There may be an excellent case for their father to give up driving, but his adult children clearly do not know how to make it.
Taking away the keys from the elder driver, selling the car, taking away his or her license, or disabling the car are also ineffective. More than that, of course, these actions violate the rights of the person and ignore his need for sympathetic understanding and treatment.
We may also infer from the father’s words quoted above that he may be fooling himself. Yes, he may possibly feel comfortable on the road (though one can doubt it) but this feeling does not mean that he remains a competent driver.
The clear fact of his having driven for more years than his children have been alive is, of course, irrelevant. It helps the man to rationalize his determination to stay on the road but will not reassure anyone else that he should continue driving.
Two presenters at the MIT conference recommended advance planning before a decision is made to stop driving. Early discussion that includes the person with dementia might reduce hard feelings. However, they admitted that such an approach has its limitations and may not work.
Another help can be to involve an authority outside the family. A physician can be such a person, but that role can be tricky. Dr. Michael Cantor, a Veterans Administration geriatrician, finds it a difficult balance to respect the rights of patients to make their own decisions and protect their confidentiality while, at the same time, feeling responsible to the public for the patient’s inability to drive safely.
One of the central findings of the researchers was to discover how the driving decision is more complicated than simply continuing to drive or giving up driving altogether. Rather, something between the two, namely self-regulation, is the choice of many people over 50. And the factor that influences people most to self-regulate is their health status. Those in poor health are much more likely to modify their driving habits, for example, by not venturing forth at night or by giving up driving in bad weather.
Conference keynoters emphasized the psychological as well as the practical meaning of operating an automobile. Maureen Mohyde of The Hartford went so far as to call driving “the key to life” and to assert “driving is everything.”
Her terminology strikes me as bordering on the absurd, even though I recognize the driving mystique that maintains its hold on so many Americans. Yes, driving enhances life by putting us in touch with other people and the great outdoors, for instance. But, in itself, it is only a means to an end and not always indispensable.
I also recognize that for many elders a car makes the difference between access to favorite activities and isolation from them. Those who live in places where public transportation does not reach may be cut off from what has been important to them. Happily, however, there are numerous elders – – including many of my friends and neighbors – – who lead active lives without depending on an automobile of their own.
Back to the brochure I recommended. It can be ordered free of charge in either English or Spanish at http:www.thehartford.com/alzheimers or by writing The Hartford, Dementia and Driving Booklet, 200 Executive Blvd., Southington, CT 06489.
Richard Griffin